Dementia Preventability and Lifestyle Factors
A significant proportion of dementia cases, estimated between 45% and 72%, may be preventable through lifestyle modifications and environmental management. The Lancet Commission attributes 45% of dementia risk to modifiable factors such as hypertension, hearing loss, obesity, physical inactivity, smoking, alcohol consumption, and low levels of early education. Other studies suggest the preventable percentage could be as high as 72% when accounting for additional factors like sleep loss and late-life physical activity. While these statistics represent population-level probabilities rather than individual guarantees, they indicate that individuals can significantly improve their odds of maintaining cognitive health by addressing these variables.
Nutritional Foundations for Brain Health
Proper brain function relies on specific nutrients that support structure and energy metabolism. Omega-3 fatty acids, particularly DHA, are critical for synaptic function and mitochondrial energy production. However, studies indicate that Omega-3 supplementation may only be effective when B-vitamin status (specifically folate, B12, and B6) is adequate, as methylation is required to incorporate DHA into cell membranes.
- DHA and Seafood: Consuming 1 to 2 grams of DHA daily, or several servings of seafood weekly, helps maintain brain structure and may protect against injury accumulation.
- Choline: This nutrient is essential for membrane health; supplementation (500–1,000 mg of citicoline) has shown benefits for cognitive decline and traumatic brain injury recovery.
- Creatine: Often used for physical performance, creatine (5–10 grams daily) also supports cognitive function and recovery from brain injury, though it may affect sleep if taken late in the day.
- Glucose Management: High blood sugar spikes can be detrimental to the brain, particularly after injury; managing glucose through diet is a key preventative strategy.
The Role of Exercise and Lactate
Physical activity is a potent tool for brain health, with different types of exercise offering unique benefits. Open-skill exercises, such as dancing, martial arts, or ball sports, are particularly effective because they combine physical exertion with complex cognitive demands like reaction speed and coordination. Dance has been shown to have a high effect size for dementia prevention due to its combination of physical, social, and musical components.
- Lactate as Fuel: High-intensity exercise generates lactate, which crosses into the brain and stimulates the release of Brain-Derived Neurotrophic Factor (BDNF), supporting hippocampal structure.
- Intensity Matters: Protocols that generate significant lactate, such as the Norwegian 4x4 (four minutes at 85–95% max heart rate, repeated four times), have shown durable benefits for brain structure over several years.
- Blood Flow Restriction (BFR): This training method can generate high levels of lactate and maintain muscle mass using low weights, making it a useful option for those travelling or recovering from injury.
Traumatic Brain Injury (TBI) Management
Strategies for recovering from brain injuries, such as concussions, focus on bridging the gap between energy supply and demand in the brain. In the acute phase following an injury, it is critical to prevent hyperthermia (fever), as increased temperature widens the metabolic deficit in the brain. Unlike in newborns, where therapeutic hypothermia (cooling) is a standard treatment for hypoxic injuries, cooling has not shown the same benefit for adult TBI.
- Immediate Interventions: Managing blood sugar to avoid spikes, taking creatine and Omega-3s, and utilising exogenous ketones can support recovery.
- Avoidance: Caffeine should be avoided early in recovery as it increases metabolic rate, which can stress the injured brain.
- Active Recovery: Early return to low-level aerobic exercise, at a threshold that does not worsen symptoms, is currently considered one of the most effective interventions for concussion recovery.
Cognitive Stimulation and Environmental Factors
Cognitive decline is often precipitated by a withdrawal from engagement with the world. Sensory loss, such as untreated cataracts or hearing loss, significantly increases dementia risk because it reduces neural input and social engagement. Correcting these issues through surgery or hearing aids can reverse this excess risk. Furthermore, error detection is a fundamental driver of neuroplasticity; the brain adapts when there is a mismatch between expectation and capacity, meaning that learning new, difficult skills (where failure occurs) is necessary to drive structural changes.
- Sleep: Adequate sleep is non-negotiable for clearing metabolic waste (like amyloid) from the brain; however, stressing about sleep tracking can be counterproductive.
- Air Quality: Exposure to air pollution is a risk factor for dementia; using high-quality air purifiers (HEPA filters) can mitigate this risk.
- Oral Health: Periodontitis is linked to increased dementia risk due to systemic inflammation and bacterial translocation; interventions like Xylitol gum can help improve the oral microbiome.